Warfarin reduces your risk of blook clots by thinning your blood. However, thinner blood increases the risk of bleeding during surgery. Therefore, you will need to stop taking your Warfarin for a few days before your operation as it takes this time to lose its activity. You will need to use enoxaparin (Clexane®) injections, which are shorter acting.

Using enoxaparin will continue to reduce your risk of blood clots. You will be given a prescription for the enoxaparin at your pre assessment appointment. You will need to collect your enoxaparin from the hospital pharmacy.

How should I take enoxaparin?

Enoxaparin needs to be taken as an injection. You should have your enoxaparin injection at the same time every day.

Your nurse or doctor will tell you how long your enoxaparin treatment will last. There are several different doses of enoxaparin depending on the reason why you are having treatment.

How should I inject enoxaparin?

Your nurse or doctor will already have shown you how to inject yourself using a enoxaparin syringe. It is important that you know the correct technique before you try to inject yourself. If you are unsure, you should ask your nurse or doctor for advice.

Step by step instructions for injecting enoxaparin

  1. First, wash your hands with soap and water. Then dry them thoroughly.
  2. Sit or lie in a comfortable position making sure that you can see the part of your stomach where you are going to inject.
  3. Choose an area on either the left or the right side of your stomach at least two inches away from your navel, out towards your side. Change the place where you inject between the left and right sides of your stomach; depending on the area you were last injected.
  4. Carefully remove the protective cap from the end of the  syringe taking care not to bend the needle. Do not press the plunger before injecting yourself to remove any air bubbles as this can lead to a loss of medicine.
  5. Hold the syringe like a pencil in the hand you normally write with. Pinch a fold of the skin you are going to inject between the thumb and index finger of your other hand.
  6. Insert the whole length of the needle into the fold of skin, keeping hold of the skin between your thumb and forefinger. Make sure you keep the needle straight and at a right angle to your body.
  7. Press down gently but firmly on the plunger until it stops and the syringe is empty. Make sure you hold the skin fold throughout the injection.
  8. Your injection is over and you can now gently pull the needle out, taking care to keep it straight. A protective sleeve will automatically cover the needle. You can now let go of the skin fold.
  9. Keeping the needle pointing down and away from you, drop the used syringe straight into the safety bin.

When the safety bin is full contact your local council to arrange for it to be collected for disposal. It is important that you do not throw this away with your household rubbish.

Top tip: Shaking the drop off the end of the needle before insertion will prevent bruising on your stomach. CHECK BEFORE YOU INJECT.

Do

  • Do make sure you keep holding the fold of skin on your abdomen until you have completely finished your injection. This will ensure that the medicine goes into the fatty tissue and not the muscle where it could cause bruising.
  • Do alternate the side of your stomach on which you inject – right one day, left the next day.
  • Do make sure you put your used syringes into the safety bin  each time you inject – never leave a used syringe lying around the house.
  • Do follow the advice of your nurse or doctor when taking your enoxaparin injections.
  • Do take your enoxaparin injection at the same time every day.
  • Do look for unusual signs of bleeding.
  • Do take care when shaving or using other sharp objects as you may bleed more easily than usual.

Don’t

  • Don’t put the enoxaparin syringe down anywhere or touch the needle with anything before you inject as this will help to keep it sterile and reduce the risk of infection.
  • Don’t twist off the needle cap, as this could bend the needle.
  • Don’t inject enoxaparin into bruised or scarred skin or anywhere that might be rubbed by clothing.
  • Don’t press the plunger before injecting yourself to remove any air bubbles.
  • Don’t rub the skin after you have injected, as this can cause bruising.
  • Don’t let anyone else use your enoxaparin syringes.
  • Don’t put enoxaparin in the fridge or the freezer – keep it at room temperature.
  • Don’t take any of these medicines while you are using enoxaparin unless your nurse or doctor tells you to: aspirin or  anything that contains aspirin or pain relievers known as non-steroidal anti-inflammatory drugs (such as ibuprofen).
  • Don’t use enoxaparin if you are hypersensitive (allergic) to Enoxaparin Sodium or Heparin.

If you notice any of the following effects, contact your nurse or doctor at once:

  • Any bleeding – for example, from the skin where you have injected, nosebleeds, blood in your urine (pink or dark brown), or if you cough up or vomit blood
  • Unusual bruising not caused by a blow or any other obvious reason

You should also tell your nurse or doctor if:

  • You have a serious fall or head injury
  • You become pregnant or you are planning to become pregnant
  • You notice any other unusual symptoms

The information in this guide is not intended to replace the advice of your nurse or doctor. If you have any questions or are unsure about how to inject enoxaparin, your community nurse or doctor will be able to help.

If you feel you will be unable to self administer the injection, we will make arrangements for you, however where possible we will ask that you try to do the injections yourself.

Ref: 23/16/102
Review: 09/18